Payment delays gnaw at dentists, patients

Chronic delays in payments to Illinois dentists for pulling teeth, filling cavities and performing root canals on state employees have created financial stress for patients and providers alike and potential disruption in needed dental services, practitioners say.

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By Dean OlsenThe State Journal-Register

The Daily Register - Harrisburg, IL

By Dean OlsenThe State Journal-Register

Posted Jul. 14, 2013 at 10:00 PM

By Dean OlsenThe State Journal-Register

Posted Jul. 14, 2013 at 10:00 PM

Editor's Note: This is the latest installment in the Deadbeat Illinois series, where reporters from GateHouse Illinois newsrooms examine the real-world effects of the state's failure to pay its bills. Each Monday, we share the stories of those affected. See more on the Deadbeat Illinois Facebook page.

Chronic delays in payments to Illinois dentists for pulling teeth, filling cavities and performing root canals on state employees have created financial stress for patients and providers alike and potential disruption in needed dental services, practitioners say.

“I love my patients who are state of Illinois employees, but sometimes you wish you had fewer of them,” said Brandon Maddox, a Springfield dentist who sits on the board of trustees for the Illinois State Dental Society. “The root of the problem is how the state is paying its bills.”

Payment delays that have grown over the past decade took on a new twist in 2011, when the state awarded a five-year contract to Delta Dental of Illinois to administer managed-care networks as part of the self-insured dental plan for state workers, retirees and dependents.

The contract involved the state paying not-for-profit Delta Dental about $12 million over the term of the contract to process between $110 million and $115 million per year in dental claims for about 350,000 people statewide.

The contract was designed to save the state $8 million to $10 million annually through the use of managed-care networks that weren’t part of the previous contract with CompBenefits.

The contract required “in-network” dentists to agree to discounts of 15 percent to 30 percent in fees they were charging previously in exchange for more timely payment from the state, according to the Illinois State Dental Society.

Patients using these dentists face lower out-of-pocket costs and can stretch their maximum $2,500 annual dental benefit farther, according to Delta Dental.

The contract initially denied dentists who opted not to be in the networks the ability to receive payments directly from the state; instead, payment checks would be sent directly to patients, and dentists would have to try to collect from them.

That provision since has been changed through legislation. Out-of-network dentists “accepting assignment” now receive direct payments from the state. But while waiting for the money, they are prohibited from asking patients to pay more than the difference between what the state insurance pays and what the dentist charges.

In-network dentists must accept what the state pays and can’t bill beyond the annual deductible.

Option to opt out

The Delta Dental contract resulted in many dentists reassessing their finances, especially in communities such as Springfield, Champaign-Urbana and other areas with concentrations of state employees, said Greg Johnson, state dental society executive director.

Page 2 of 3 - For some Springfield dentists, half or more of their patients are insured through the state, Johnson said.

“I think dentists have adapted,” he said. “They still don’t like it.”

Some Illinois dentists opted not to be in the networks and not accept assignment because they didn’t want to wait more than six months to be paid. Some decided to bill patients up front or work out payment plans.

Patients don’t appreciate being told to pay an entire bill — which can reach $1,000 or more in a single visit — before they leave a dentist office. But because of payment delays, this is happening during dental and medical visits, and it is causing hardships, said Henry Bayer, executive director of Chicago-based Council 31 of the American Federation of State, County and Municipal Employees.

AFSCME has called for the state to borrow to pay down the backlog of bills, but there hasn’t been agreement among lawmakers on this option, so borrowing hasn’t taken place.

Tough decision

Maddox, an out-of-network dentist who doesn’t accept assignment, said he can’t afford the fee reductions required by Delta, and he can’t afford to wait months without being paid.

He offers patients discounts for paying their bill all at once. He also offers no-interest financing. Patients often understand his dilemma after he explains the details. But some don’t sympathize.

“I have lost patients because of this,” Maddox said.

Maddox said he feels bad for patients who have to delay treatment so they can save up for procedures rather than have dental problems addressed right away.

When patients delay care, their dental decay can worsen, requiring even more repairs, more suffering and bigger bills to the state, he said.

Todd Maggiore, another Springfield dentist who has opted not to be a network provider or accept assignment, said the payment delays have been “a tremendous hardship for our business as well as for our patients.”

Maggiore often works out payment plans with patients.

“We have bent over backwards to be as flexible as we can,” he said.

Most patients, he said, “realize how broken our government has been and how irresponsible the state has been.”

Maggiore, too, has lost patients who initially decided to leave for an in-network dentist. Some of those patients regretted their decision and returned, he said.

“I’ve had a few patients come back in pain and unhappy,” he said.

Page 3 of 3 - Dean Olsen can be reached at (217) 788-1543. Follow him at twitter.com/DeanOlsenSJR.